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SAN JOA <br /> Q �ONMENTAL gE <br /> ENCOUNTY AI,THTSIflENRtIICE5 <br /> ANNUAL INVENTORY RECONCILIATION SUiIl2 Ry REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> ev- <br /> Facility Name <br /> ev- city <br /> Address 7 f +'�'� <br /> ElAll inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , Californiae2Code ofp Regulations,Division 3 , Chapter 16, Section 2645, fo rJ <br /> 19 y `� to 19�- �` <br /> Inventory variations inexcessof the allowable limits of Section <br /> 2646, occurred as listed <br /> , <br /> DATE <br /> TANK / PRODUCT {AMOUNT (Gallons) <br /> 04,c d <br /> fJl � eC e 10 i <br /> Submit report within 15 days following the art to the <br /> heslast month <br /> ed of the <br /> 12-month period covered by the report. Rep <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE$ <br /> ENVIRON24ENTAL HEALTH DIVISION <br /> P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> I certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Safety Code, section 25299) : <br /> Date <br /> Facility Tank Operator/Ower <br /> n <br /> EH 23 019 8-1-92 <br />